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returned to senatepassed assemblyordered to third reading rules cal.389substituted for a9586dreferred to codesdelivered to assemblypassed senateordered to third reading cal.1308committee discharged and committed to rules

S6769 - Details

S6769 - Summary

Relates to duties of providers of mammography services to notify and inform patients if a mammogram demonstrates dense breast tissue.

S6769 - Sponsor Memo

BILL NUMBER:S6769
TITLE OF BILL:
An act
to amend the insurance law and the public health law, in relation to
supplemental screenings
PURPOSE:
This bill requires health insurance policies to provide additional
coverage for supplementary screening tests for breast cancer when a
mammography indicates dense breast tissue. It also requires specific
written notification to the patient and the patient's physician of a
finding of dense tissue and the need to consult with the physician
about additional screening.
SUMMARY OF PROVISIONS:
Section one amends subparagraphs (A) and (C) of paragraph 11 of
subsection (i) of section 3216 of the insurance law, as amended by
chapter 219 of the laws of 2011, to require insurance Coverage for
Supplementary screening tests to detect occult breast cancer Upon
recommendation of a physician in those cases where a mammography
indicates the presence of dense breast tissue as defined by the
breast imaging reporting and data system established by the American
College of Radiology, or a physician determines that the covered
person is potentially at high risk for breast cancer according to
such guidelines. Other imaging modalities are defined as modalities

used to screen for, or diagnose, breast cancer.
Section two amends subparagraphs (A) and (C) of paragraph 11 of
subsection (1) of section 3221 of the insurance law, as amended by
chapter 219 of the laws of 2011, in exactly the same way as section
one above.
Section three amends subsection (p) of section 4303 of the insurance
law, as amended by chapter 219 of the laws of 2011, in exactly the
same way as section one above.
Section four amends paragraph 7 of subsection (d) of section 4326 of
the insurance law, as added by chapter 1 of the laws of 1999, by
adding a cross reference to subsection (p) of section 4303 of the
insurance law.
Section five amends the public health law by adding a new section
2404-c which requires the commissioner to develop a written
notification informing patients who have dense tissue: that their
mammography found dense tissue, that they have dense tissue, that
dense tissue may reduce the sensitivity of mammography screening and
interfere with the detection of abnormalities, that their physician
has been notified, and that they should consult with their physician
about further screening options. The notification will be included
with the federally required mammography report sent to the patient
and patient's physician.
Section six sets forth the effective date on the ninetieth day after
it shall have become a law.
EXISTING LAW:
Current law requires coverage for mammography screening for
individuals, based upon personal or family history and the age of the
individual.
Mammography screening is defined as X-ray examination under current law.
There are no requirements for patients to be alerted to breast density.
JUSTIFICATION:
One woman is diagnosed with breast cancer every three minutes, and one
woman dies of breast cancer every 13 minutes in the United States.
Cancer is four to six times more likely in women with dense breast
tissue and 40 percent of women have dense tissue. 71 percent of all
breast cancers occur in women with dense breast tissue (as stated in
a 2010 study published in the Annals of Surgical Oncology).
Mammograms fail to detect about half the tumors present in dense
breast tissue as dense tissue obscures the presence of the tumors.
Follow-up studies after a similar dense breast tissue law passed in
Connecticut in 2009 show that for women with dense tissue, the
addition of a screening ultrasound nearly doubles the number of
cancers found by mammography alone. In New York State, that number
extrapolates to at least 2000 cancers a year in women who are told
their mammogram results are "normal/negative," but who, in actuality,
have invasive breast cancer.
Missed cancers, growing undetected until at a later stage, are less
treatable, least survivable and most expensive to treat.
Over 20 years ago, elected officials and medical experts reached a
consensus that early breast cancer detection saved lives and states
began requiring insurance coverage for mammograms. In order to ensure
that patients received information about relevant mammographic
findings, a federal law was enacted requiring a mammography report be
issued to patients to help them partner with their physician in their
health care vigilance.
A woman's breast density is determined through the mammography exam.
Breast density not only dramatically compromises the effectiveness of
a mammogram, but is, in and of itself, a risk factor for developing
breast cancer. Women with dense breasts have a greater risk of
developing breast cancer than those who have a first degree relative
who have had the disease. Unfortunately, there is currently no
protocol for density information to be shared with patients. The
mammography reports to patients, citing a "normal" finding when the
radiologist does not know, with any reasonable certainty what is
lurking behind dense tissue - gives women a false sense of security.
Now, twenty years later, states are recognizing that, for a
significant percentage of women, the mammography insurance coverage
and notification requirements are not sufficient. The report a woman
receives after her mammogram is required to be a summary, in lay
language, of her mammographic findings. Information about breast
density is a material medical finding which must be shared with
patients. This legislation will give women with dense tissue the
information and opportunity to get adequate baseline and follow-up
screening. Without it, women with dense tissue are effectively denied
equal access to early cancer detection.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
None.
LOCAL FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This bill takes effect on the ninetieth day after it shall have become
a law.

S T A T E O F N E W Y O R K
________________________________________________________________________
S. 6769 A. 9586
S E N A T E - A S S E M B L Y
March 20, 2012
___________
IN SENATE -- Introduced by Sen. FLANAGAN -- read twice and ordered
printed, and when printed to be committed to the Committee on Insur-
ance
IN ASSEMBLY -- Introduced by M. of A. JAFFEE -- read once and referred
to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to supplemental screenings
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraphs (A) and (C) of paragraph 11 of subsection (i)
of section 3216 of the insurance law, as amended by chapter 219 of the
laws of 2011, are amended to read as follows:
(A) Every policy that provides coverage for hospital, surgical or
medical care shall provide the following coverage for mammography AND
OTHER IMAGING screening for occult breast cancer:
(i) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
(iii) an annual mammogram for covered persons aged forty and older;
AND
(IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES DEEMED APPROPRIATE FOR
ADJUVANT SCREENING BY AMERICAN COLLEGE OF RADIOLOGY GUIDELINES TO DETECT
OCCULT BREAST CANCER IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DOES NOT
PROVIDE ADEQUATE SCREENING BECAUSE OF THE NATURE OF THE BREAST TISSUE,
INCLUDING, BUT NOT LIMITED TO, THE PRESENCE OF HETEROGENEOUSLY OR
EXTREMELY DENSE BREAST TISSUE, AS DEFINED BY THE BREAST IMAGING REPORT-
ING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY,
THAT MAY LOWER THE SENSITIVITY OF MAMMOGRAPHY; OR,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15074-01-2

S. 6769 2 A. 9586
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST CANCER ACCORDING TO SUCH GUIDELINES.
(C) (I) For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.
(II) FOR PURPOSES OF SUBPARAGRAPHS (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES USED TO SCREEN FOR, OR DIAGNOSE,
OCCULT BREAST CANCER.
S 2. Subparagraphs (A) and (C) of paragraph 11 of subsection (l) of
section 3221 of the insurance law, as amended by chapter 219 of the laws
of 2011, are amended to read as follows:
(A) Every insurer delivering a group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides cover-
age for hospital, surgical or medical care shall provide the following
coverage for mammography AND OTHER IMAGING screening for occult breast
cancer:
(i) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
(iii) an annual mammogram for covered persons aged forty and older;
AND
(IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES DEEMED APPROPRIATE FOR
ADJUVANT SCREENING BY AMERICAN COLLEGE OF RADIOLOGY GUIDELINES TO DETECT
OCCULT BREAST CANCER IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DOES NOT
PROVIDE ADEQUATE SCREENING BECAUSE OF THE NATURE OF THE BREAST TISSUE,
INCLUDING, BUT NOT LIMITED TO, THE PRESENCE OF HETEROGENEOUSLY OR
EXTREMELY DENSE BREAST TISSUE, AS DEFINED BY THE BREAST IMAGING REPORT-
ING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY,
THAT MAY LOWER THE SENSITIVITY OF MAMMOGRAPHY; OR,
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST CANCER ACCORDING TO SUCH GUIDELINES.
(C) (I) For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.
(II) FOR PURPOSES OF SUBPARAGRAPHS (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES USED TO SCREEN FOR, OR DIAGNOSE,
OCCULT BREAST CANCER.
S 3. Subsection (p) of section 4303 of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
(p) (1) A medical expense indemnity corporation, a hospital service
corporation or a health service corporation that provides coverage for
hospital, surgical or medical care shall provide the following coverage
for mammography AND OTHER IMAGING screening for occult breast cancer:
(A) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(B) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
S. 6769 3 A. 9586
(C) an annual mammogram for covered persons aged forty and older[.];
AND
(D) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES DEEMED APPROPRIATE FOR
ADJUVANT SCREENING BY AMERICAN COLLEGE OF RADIOLOGY GUIDELINES TO DETECT
OCCULT BREAST CANCER IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DOES NOT
PROVIDE ADEQUATE SCREENING BECAUSE OF THE NATURE OF THE BREAST TISSUE,
INCLUDING, BUT NOT LIMITED TO, THE PRESENCE OF HETEROGENEOUSLY OR
EXTREMELY DENSE BREAST TISSUE, AS DEFINED BY THE BREAST IMAGING REPORT-
ING AND DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY,
THAT MAY LOWER THE SENSITIVITY OF MAMMOGRAPHY; OR,
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST CANCER ACCORDING TO SUCH GUIDELINES.
(E) The coverage required in this paragraph or paragraph two of this
subsection may be subject to annual deductibles and coinsurance as may
be deemed appropriate by the superintendent and as are consistent with
those established for other benefits within a given contract.
(2) (A) For purposes of paragraph one of this subsection, mammography
screening means an X-ray examination of the breast using dedicated
equipment, including X-ray tube, filter, compression device, screens,
films and cassettes, with an average glandular radiation dose less than
0.5 rem per view per breast.
(B) FOR PURPOSES OF PARAGRAPH ONE OF THIS SUBSECTION, IMAGING MODALI-
TIES ARE MODALITIES USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST
CANCER.
(3) In addition to paragraph one or two of this subsection, every
contract that provides coverage for hospital, surgical or medical care,
except for a grandfathered health plan under paragraph four of this
subsection, shall provide coverage for the following mammography screen-
ing services, and such coverage shall not be subject to annual deduct-
ibles or coinsurance:
(A) evidence-based items or services for mammography that have in
effect a rating of 'A' or 'B' in the current recommendations of the
United States preventive services task force; and
(B) with respect to women, such additional preventive care and screen-
ings for mammography not described in subparagraph (A) of this paragraph
and as provided for in comprehensive guidelines supported by the health
resources and services administration.
(4) For purposes of this subsection, "grandfathered health plan" means
coverage provided by a corporation in which an individual was enrolled
on March twenty-third, two thousand ten for as long as the coverage
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e).
S 4. Paragraph 7 of subsection (d) of section 4326 of the insurance
law, as added by chapter 1 of the laws of 1999, is amended to read as
follows:
(7) adult preventive health services consisting of mammography screen-
ing, AS PROVIDED IN SUBSECTION (P) OF SECTION FOUR THOUSAND THREE
HUNDRED THREE OF THIS ARTICLE; cervical cytology screening; periodic
physical examinations no more than once every three years; and adult
immunizations;
S 5. The public health law is amended by adding a new section 2404-c
to read as follows:
S 2404-C. BREAST CANCER; DUTY OF PROVIDERS OF MAMMOGRAPHY SERVICES TO
NOTIFY AND INFORM. 1. THE COMMISSIONER SHALL DEVELOP A STANDARD WRITTEN
S. 6769 4 A. 9586
NOTIFICATION IN PLAIN NON-TECHNICAL LANGUAGE FOR PATIENTS, WHO RECEIVE
MAMMOGRAPHY SERVICES THAT DEMONSTRATE THE PATIENT HAS HETEROGENEOUSLY OR
EXTREMELY DENSE BREAST TISSUE BASED ON THE BREAST IMAGING REPORTING AND
DATA SYSTEM ESTABLISHED BY THE AMERICAN COLLEGE OF RADIOLOGY, WHICH
SHALL EXPLAIN THAT:
(A) THE PATIENT'S MAMMOGRAPHY RESULTS DEMONSTRATE THAT THE PATIENT HAS
DENSE BREAST TISSUE WHICH MAY REDUCE THE SENSITIVITY OF MAMMOGRAPHY
SCREENING AND INTERFERE WITH THE DETECTION OF ABNORMALITIES;
(B) THE NOTIFICATION HAS ALSO BEEN SENT TO THE PATIENT'S PHYSICIAN;
AND,
(C) THE NOTIFICATION IS PROVIDED TO ENCOURAGE THE PATIENT TO DISCUSS
WITH THE PATIENT'S PHYSICIAN THE OPTION OF ADDITIONAL METHODS OF SCREEN-
ING FOR BREAST CANCER DEPENDING ON THE PATIENT'S RISK FACTORS.
2. EVERY PROVIDER OF MAMMOGRAPHY SERVICES SHALL, IF A PATIENT HAS
HETEROGENEOUSLY DENSE OR EXTREMELY DENSE BREAST TISSUE, INCLUDE SUCH
NOTIFICATION IN ANY MAMMOGRAPHY REPORT SENT, PURSUANT TO THE FEDERAL
MAMMOGRAPHY QUALITY STANDARDS ACT, TO THE PATIENT AND THE PATIENT'S
PHYSICIAN.
S 6. This act shall take effect on the ninetieth day after it shall
have become a law.

S6769A - Details

S6769A - Summary

Relates to duties of providers of mammography services to notify and inform patients if a mammogram demonstrates dense breast tissue.

S6769A - Sponsor Memo

BILL NUMBER:S6769A
TITLE OF BILL:
An act
to amend the insurance law and the public health law, in relation to
supplemental screenings
PURPOSE:
This bill requires health insurance policies to provide
additional coverage for supplementary screening tests for breast
cancer when a mammography indicates dense breast tissue. It also
requires specific written notification to the patient and the
patient's physician of a finding of dense tissue and the need to
consult with the physician about additional screening.
SUMMARY OF PROVISIONS:
Section one amends subparagraphs (A) and (C) of
paragraph 11 of subsection (i) of section 3216 of the insurance law,
as amended by chapter 219 of the laws of 2011, to require insurance
coverage for supplementary screening tests to detect occult breast
cancer upon recommendation of a physician in those cases where a
mammography demonstrates the presence of dense breast tissue as
defined by the breast imaging reporting and data system established
by the American College of Radiology, or a physician determines that
the covered person is potentially at high risk for breast cancer
according to recognized medical practice guidelines. Other imaging

modalities are defined as modalities approved by the Federal Food and
Drug Administration (FDA) used to screen for, or diagnose, breast
cancer.
Section two amends subparagraphs (A) and (C) of paragraph 11 of
subsection (1) of section 3221 of the insurance law, as amended by
chapter 219 of the laws of 2011, in exactly the same way as section
one above.
Section three amends subsection (p) of section 4303 of the insurance
law, as amended by chapter 219 of the laws of 2011, in exactly the
same way as section one above.
Section four amends paragraph of subsection (d) of section 4326 of the
insurance law, as added by chapter 1 of the laws of 1999, by adding a
cross reference to subsection (p) of section 4303 of the insurance law.
Section five amends the public health law by adding a new section
2404-c which requires mammography providers to include the following
information in the summary of the mammography report provided to
patients who have dense tissue as defined in the bill:
Your mammogram shows that your breast tissue is dense. Dense breast
tissue is very common and is not abnormal. However, dense breast
tissue can make it harder to find cancer on a mammogram and may also
increase your breast cancer risk.
This information about the result of your mammogram is given to you to
raise your awareness. Use this information to talk to your doctor
about your own risks for breast cancer. At that time, ask your doctor
if more screening tests might be useful, based on your risk. A report
of your results was sent to your physician.
Section six sets forth the effective date on the one hundred eightieth
day after it shall have become a law.
EXISTING LAW:
Current law requires coverage for mammography screening
for individuals, based upon personal or family history and the age of
the individual.
Mammography screening is defined as X-ray examination under current
law. There are no requirements for patients to be alerted to breast
density.
JUSTIFICATION:
One woman is diagnosed with breast cancer every three
minutes, and one woman dies of breast cancer every 13 minutes in the
United States. Cancer is four to six times more likely in women with
dense breast tissue and 40% of women have dense tissue. According to
a 2010 study published in the Annals of Surgical Oncology, 71% of
all breast cancers occur in women with dense breast tissue.
Mammograms fail to detect about half the tumors present in dense
breast tissue as dense tissue obscures the presence of the tumors.
Follow-up studies after a similar dense breast tissue law passed in
Connecticut in 2009 show that for women with dense tissue, the
addition of a screening ultrasound nearly doubles the number of
cancers found by mammography alone. In New York State, that number
extrapolates to at least 2000 cancers a year in women who are told
their mammogram results are "normal/negative," but who, in actuality,
have invasive breast cancer. Missed cancers, growing undetected until
at a later stage, are less treatable, least survivable and most
expensive to treat.
Over 20 years ago, elected officials and medical experts reached a
consensus that early breast cancer detection saved lives and states
began requiring insurance coverage for mammograms. In order to ensure
that patients received information about relevant mammographic
findings, a federal law was enacted requiring a mammography report be
issued to patients to help them partner with their physician in their
health care vigilance.
A woman's breast density is determined through the mammography exam.
Breast density not only dramatically compromises the effectiveness of
a mammogram, but is, in and of itself, a risk factor for developing
breast cancer. Women with dense breasts have a greater risk of
developing breast cancer than those who have a first degree relative
who have had
the disease. Unfortunately, there is currently no protocol for density
information to he shared with patients. The mammography reports to
patients, citing a "normal" finding when the radiologist does not
know, with any reasonable certainty what is lurking behind dense
tissue - give women a false sense of security.
Now, twenty years later, states are recognizing that, for a
significant percentage of women, the mammography insurance coverage
and notification requirements are not sufficient. The report a woman
receives after her mammogram is required to be a summary, in lay
language, of her mammographic findings, Information about breast
density is a material medical finding which must be shared with
patients. This legislation will give women with dense tissue the
information and opportunity to get adequate baseline and follow-up
screening. Without it, women with dense tissue are effectively denied
equal access to early cancer detection.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATION
None.
LOCAL FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This bill takes effect on the one hundred eightieth
day after it shall have become a law.

S T A T E O F N E W Y O R K
________________________________________________________________________
S. 6769--A A. 9586--A
S E N A T E - A S S E M B L Y
March 20, 2012
___________
IN SENATE -- Introduced by Sens. FLANAGAN, ALESI, BALL, GOLDEN, GRISAN-
TI, HUNTLEY, JOHNSON, LAVALLE, OPPENHEIMER, PARKER, RITCHIE, STAVISKY,
STEWART-COUSINS -- read twice and ordered printed, and when printed to
be committed to the Committee on Insurance -- committee discharged,
bill amended, ordered reprinted as amended and recommitted to said
committee
IN ASSEMBLY -- Introduced by M. of A. JAFFEE, SWEENEY, GUNTHER, McENENY,
ABINANTI, LANCMAN, COLTON, JACOBS, MILLMAN, BARRON, N. RIVERA, MAISEL,
HOOPER, ROBERTS, RUSSELL, CASTRO, QUART, CAHILL, GALEF, ENGLEBRIGHT,
O'DONNELL, SCHIMEL, SCARBOROUGH, WEPRIN, LINARES, COOK, ROBINSON,
CLARK, CYMBROWITZ, LATIMER, LIFTON, LAVINE, BRAUNSTEIN, PRETLOW, MOYA,
J. RIVERA, GRAF -- Multi-Sponsored by -- M. of A. AMEDORE, ARROYO,
AUBRY, BRENNAN, BURLING, CALHOUN, CONTE, CROUCH, CURRAN, DUPREY,
HAWLEY, HEVESI, LOSQUADRO, PEOPLES-STOKES, PERRY, RA, RAIA, P. RIVERA,
SALADINO, SAYWARD, TENNEY, THIELE, TITONE, WEISENBERG -- read once and
referred to the Committee on Insurance -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee
AN ACT to amend the insurance law and the public health law, in relation
to supplemental screenings
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraphs (A) and (C) of paragraph 11 of subsection (i)
of section 3216 of the insurance law, as amended by chapter 219 of the
laws of 2011, are amended to read as follows:
(A) Every policy that provides coverage for hospital, surgical or
medical care shall provide the following coverage for mammography AND
OTHER IMAGING screening for occult breast cancer:
(i) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.

LBD15074-03-2
S. 6769--A 2 A. 9586--A
(iii) an annual mammogram for covered persons aged forty and older;
AND
(IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES FOR ADJUVANT SCREENING IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST CANCER IN ACCORDANCE WITH RECOGNIZED
PRACTICE GUIDELINES OR RISK ASSESSMENT TOOLS.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL HAVE
THE SAME MEANING AS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS
DEFINED BY THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY
THE AMERICAN COLLEGE OF RADIOLOGY AND ANY EQUIVALENT NEW TERMS AS SUCH
SYSTEM IS UPDATED.
(C) (I) For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.
(II) FOR PURPOSES OF SUBPARAGRAPHS (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES, APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION, USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST CANCER.
S 2. Subparagraphs (A) and (C) of paragraph 11 of subsection (l) of
section 3221 of the insurance law, as amended by chapter 219 of the laws
of 2011, are amended to read as follows:
(A) Every insurer delivering a group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides cover-
age for hospital, surgical or medical care shall provide the following
coverage for mammography AND OTHER IMAGING screening for occult breast
cancer:
(i) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(ii) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
(iii) an annual mammogram for covered persons aged forty and older;
AND
(IV) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES FOR ADJUVANT SCREENING IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST CANCER IN ACCORDANCE WITH RECOGNIZED
PRACTICE GUIDELINES OR RISK ASSESSMENT TOOLS.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL HAVE
THE SAME MEANING AS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS
DEFINED BY THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY
THE AMERICAN COLLEGE OF RADIOLOGY AND ANY EQUIVALENT NEW TERMS AS SUCH
SYSTEM IS UPDATED.
(C) (I) For purposes of subparagraphs (A) and (B) of this paragraph,
mammography screening means an X-ray examination of the breast using
dedicated equipment, including X-ray tube, filter, compression device,
screens, films and cassettes, with an average glandular radiation dose
less than 0.5 rem per view per breast.
S. 6769--A 3 A. 9586--A
(II) FOR PURPOSES OF SUBPARAGRAPHS (A) AND (B) OF THIS PARAGRAPH,
IMAGING MODALITIES ARE MODALITIES, APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION, USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST CANCER.
S 3. Subsection (p) of section 4303 of the insurance law, as amended
by chapter 219 of the laws of 2011, is amended to read as follows:
(p) (1) A medical expense indemnity corporation, a hospital service
corporation or a health service corporation that provides coverage for
hospital, surgical or medical care shall provide the following coverage
for mammography AND OTHER IMAGING screening for occult breast cancer:
(A) upon the recommendation of a physician, a mammogram at any age for
covered persons having a prior history of breast cancer or who have a
first degree relative with a prior history of breast cancer;
(B) a single baseline mammogram for covered persons aged thirty-five
through thirty-nine, inclusive; [and]
(C) an annual mammogram for covered persons aged forty and older[.];
AND
(D) UPON RECOMMENDATION OF A PHYSICIAN, SUPPLEMENTAL SCREENING FOR A
COVERED PERSON USING OTHER IMAGING MODALITIES FOR ADJUVANT SCREENING IF:
(A) A MAMMOGRAM PERFORMED PURSUANT TO THIS SUBPARAGRAPH DEMONSTRATES
THAT THE COVERED PERSON HAS DENSE BREAST TISSUE; OR,
(B) IT IS DETERMINED BY A PHYSICIAN THAT THE COVERED PERSON IS POTEN-
TIALLY AT HIGH RISK FOR BREAST CANCER IN ACCORDANCE WITH RECOGNIZED
PRACTICE GUIDELINES OR RISK ASSESSMENT TOOLS.
FOR THE PURPOSES OF THIS SUBPARAGRAPH DENSE BREAST TISSUE SHALL HAVE
THE SAME MEANING AS HETEROGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS
DEFINED BY THE BREAST IMAGING REPORTING AND DATA SYSTEM ESTABLISHED BY
THE AMERICAN COLLEGE OF RADIOLOGY AND ANY EQUIVALENT NEW TERMS AS SUCH
SYSTEM IS UPDATED.
(E) The coverage required in this paragraph or paragraph two of this
subsection may be subject to annual deductibles and coinsurance as may
be deemed appropriate by the superintendent and as are consistent with
those established for other benefits within a given contract.
(2) (A) For purposes of paragraph one of this subsection, mammography
screening means an X-ray examination of the breast using dedicated
equipment, including X-ray tube, filter, compression device, screens,
films and cassettes, with an average glandular radiation dose less than
0.5 rem per view per breast.
(B) FOR PURPOSES OF PARAGRAPH ONE OF THIS SUBSECTION, IMAGING MODALI-
TIES ARE MODALITIES, APPROVED BY THE FEDERAL FOOD AND DRUG ADMINIS-
TRATION, USED TO SCREEN FOR, OR DIAGNOSE, OCCULT BREAST CANCER.
(3) In addition to paragraph one or two of this subsection, every
contract that provides coverage for hospital, surgical or medical care,
except for a grandfathered health plan under paragraph four of this
subsection, shall provide coverage for the following mammography screen-
ing services, and such coverage shall not be subject to annual deduct-
ibles or coinsurance:
(A) evidence-based items or services for mammography that have in
effect a rating of 'A' or 'B' in the current recommendations of the
United States preventive services task force; and
(B) with respect to women, such additional preventive care and screen-
ings for mammography not described in subparagraph (A) of this paragraph
and as provided for in comprehensive guidelines supported by the health
resources and services administration.
(4) For purposes of this subsection, "grandfathered health plan" means
coverage provided by a corporation in which an individual was enrolled
on March twenty-third, two thousand ten for as long as the coverage
S. 6769--A 4 A. 9586--A
maintains grandfathered status in accordance with section 1251(e) of the
Affordable Care Act, 42 U.S.C. S 18011(e).
S 4. Paragraph 7 of subsection (d) of section 4326 of the insurance
law, as added by chapter 1 of the laws of 1999, is amended to read as
follows:
(7) adult preventive health services consisting of mammography screen-
ing, AS PROVIDED IN SUBSECTION (P) OF SECTION FOUR THOUSAND THREE
HUNDRED THREE OF THIS ARTICLE; cervical cytology screening; periodic
physical examinations no more than once every three years; and adult
immunizations;
S 5. The public health law is amended by adding a new section 2404-c
to read as follows:
S 2404-C. BREAST CANCER; DUTY OF PROVIDERS OF MAMMOGRAPHY SERVICES TO
NOTIFY AND INFORM. EVERY PROVIDER OF MAMMOGRAPHY SERVICES SHALL, IF A
PATIENT'S MAMMOGRAM DEMONSTRATES DENSE BREAST TISSUE AS DEFINED IN
SECTION THREE THOUSAND TWO HUNDRED SIXTEEN OF THE INSURANCE LAW,
INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING INFORMATION, IN ANY SUMMA-
RY OF THE MAMMOGRAPHY REPORT SENT, PURSUANT TO THE FEDERAL MAMMOGRAPHY
QUALITY STANDARDS ACT, TO THE PATIENT AND THE PATIENT'S PHYSICIAN:
YOUR MAMMOGRAM SHOWS THAT YOUR BREAST TISSUE IS DENSE. DENSE BREAST
TISSUE IS VERY COMMON AND IS NOT ABNORMAL. HOWEVER, DENSE BREAST TISSUE
CAN MAKE IT HARDER TO FIND CANCER ON A MAMMOGRAM AND MAY ALSO INCREASE
YOUR BREAST CANCER RISK.
THIS INFORMATION ABOUT THE RESULT OF YOUR MAMMOGRAM IS GIVEN TO YOU TO
RAISE YOUR AWARENESS. USE THIS INFORMATION TO TALK TO YOUR DOCTOR ABOUT
YOUR OWN RISKS FOR BREAST CANCER. AT THAT TIME, ASK YOUR DOCTOR IF MORE
SCREENING TESTS MIGHT BE USEFUL, BASED ON YOUR RISK. A REPORT OF YOUR
RESULTS WAS SENT TO YOUR PHYSICIAN.
S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law.

S6769B (ACTIVE) - Details

S6769B (ACTIVE) - Summary

Relates to duties of providers of mammography services to notify and inform patients if a mammogram demonstrates dense breast tissue.

S6769B (ACTIVE) - Sponsor Memo

BILL NUMBER:S6769B REVISED 06/15/12
TITLE OF BILL:
An act
to amend the public health law, in relation to
supplemental screenings
PURPOSE:
This bill requires specific written notification to the patient of a
finding of dense breast tissue on a mammogram, an explanation of what
that means and a recommendation to consult with the patient's
physician about additional screening.
SUMMARY OF PROVISIONS:
Section one amends the public health law by adding a new section
2404-c which requires mammography providers to include the following
notification in the summary of the mammography report provided to
patients who have dense tissue as defined in the bill:
Your mammogram shows that your breast tissue is dense. Dense breast
tissue is very common and is not abnormal. However, dense breast
tissue can make it harder to find cancer on a mammogram and may also
be associated with an increased risk of breast cancer.
This information about the result of your mammogram is given to you to
raise your awareness. Use this information to talk to your doctor

about your own risks for breast cancer. At that time, ask your doctor
if more screening tests might be useful, based on your risk. A report
of your results was sent to your physician.
Dense breast tissue shall mean heterogeneously or extremely dense
tissue as defined in nationally recognized guidelines or systems for
breast imaging reporting of mammography screening, including, but not
limited to, the Breast Imaging Reporting and Data System (BIRADS) of
the American College of Radiology, and any equivalent new terms, as
such guidelines or systems are updated.
Section two sets forth the effective date as the one hundred eightieth
day after it shall have become a law.
EXISTING LAW:
There are no requirements in law for patients to be alerted to breast
density.
JUSTIFICATION:
One woman is diagnosed with breast cancer every three minutes, and one
woman dies of breast cancer every 13 minutes in the United States.
Cancer is four to six times more likely in women with dense breast
tissue and 40% of women have dense tissue. According to a 2010 study
published in the Annals of Surgical Oncology, 71% of all breast
cancers occur in women with dense breast tissue. Mammograms fail to
detect about
half the tumors present in dense breast tissue as dense tissue
obscures the presence of the tumors. Follow-up studies after a
similar dense breast tissue law passed in Connecticut in 2009 show
that for women with dense tissue, the addition of a screening
ultrasound nearly doubles the number of cancers found by mammography
alone. In New York State, that number extrapolates to at least 2000
cancers a year in women who are told their mammogram results are
"normal/negative," but who, in actuality, have invasive breast
cancer. Missed cancers, growing undetected until at a later stage,
are less treatable, least survivable and most expensive to treat.
Over 20 years ago, elected officials and medical experts reached a
consensus that early breast cancer detection saved lives and states
began requiring insurance coverage for mammograms. In order to
ensure that patients received information about relevant mammographic
findings, a federal law was enacted requiring a mammography report be
issued to patients to help them partner with their physician in their
health care vigilance.
A woman's breast density is determined through the mammography exam.
Breast density not only dramatically compromises the effectiveness of
a mammogram, but is, in and of itself, a risk factor for developing
breast cancer. Women with dense breasts have a greater risk of
developing breast cancer than those who have a first degree relative
who have had the disease. Unfortunately, there is currently no
protocol for density information to be shared with patients. The
mammography reports to patients citing a "normal" finding - when the
radiologist does not know, with any reasonable certainty what is
lurking behind dense tissue - give women a false sense of security.
Now, twenty years later, states are recognizing that, for a
significant percentage of women, the mammography notification
requirements are not sufficient. The report a woman receives after
her mammogram is required to be a summary, in lay language, of her
mammographic findings. Information about breast density is a
material medical finding which must be shared with patients. This
legislation will give women with dense tissue the information to talk
to their physician about getting adequate baseline and follow-up
screening. Without it, women with dense tissue may be effectively
denied equal access to early cancer detection without even knowing it.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This bill takes effect on the one hundred eightieth day after it shall
have become a law.

S T A T E O F N E W Y O R K
________________________________________________________________________
6769--B
I N S E N A T E
March 20, 2012
___________
Introduced by Sens. FLANAGAN, ALESI, BALL, GOLDEN, GRISANTI, HUNTLEY,
JOHNSON, LAVALLE, OPPENHEIMER, PARKER, PERKINS, RITCHIE, STAVISKY,
STEWART-COUSINS -- read twice and ordered printed, and when printed to
be committed to the Committee on Insurance -- committee discharged,
bill amended, ordered reprinted as amended and recommitted to said
committee -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the public health law, in relation to supplemental
screenings
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding a new section
2404-c to read as follows:
S 2404-C. BREAST CANCER; DUTY OF PROVIDERS OF MAMMOGRAPHY SERVICES TO
NOTIFY AND INFORM. EVERY PROVIDER OF MAMMOGRAPHY SERVICES SHALL, IF A
PATIENT'S MAMMOGRAM DEMONSTRATES DENSE BREAST TISSUE, PROVIDE NOTIFICA-
TION TO SUCH PATIENT THAT SHALL INCLUDE, BUT NOT BE LIMITED TO, THE
FOLLOWING INFORMATION, IN ANY SUMMARY OF THE MAMMOGRAPHY REPORT SENT,
PURSUANT TO THE FEDERAL MAMMOGRAPHY QUALITY STANDARDS ACT, TO THE
PATIENT:
YOUR MAMMOGRAM SHOWS THAT YOUR BREAST TISSUE IS DENSE. DENSE BREAST
TISSUE IS VERY COMMON AND IS NOT ABNORMAL. HOWEVER, DENSE BREAST TISSUE
CAN MAKE IT HARDER TO FIND CANCER ON A MAMMOGRAM AND MAY ALSO BE ASSOCI-
ATED WITH AN INCREASED RISK OF BREAST CANCER.
THIS INFORMATION ABOUT THE RESULT OF YOUR MAMMOGRAM IS GIVEN TO YOU TO
RAISE YOUR AWARENESS. USE THIS INFORMATION TO TALK TO YOUR DOCTOR ABOUT
YOUR OWN RISKS FOR BREAST CANCER. AT THAT TIME, ASK YOUR DOCTOR IF MORE
SCREENING TESTS MIGHT BE USEFUL, BASED ON YOUR RISK. A REPORT OF YOUR
RESULTS WAS SENT TO YOUR PHYSICIAN.
FOR THE PURPOSES OF THIS SECTION DENSE BREAST TISSUE SHALL MEAN HETER-
OGENEOUSLY DENSE OR EXTREMELY DENSE TISSUE AS DEFINED IN NATIONALLY
RECOGNIZED GUIDELINES OR SYSTEMS FOR BREAST IMAGING REPORTING OF MAMMOG-
RAPHY SCREENING, INCLUDING, BUT NOT LIMITED TO, THE BREAST IMAGING
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15074-11-2

S. 6769--B 2
REPORTING AND DATA SYSTEM OF THE AMERICAN COLLEGE OF RADIOLOGY, AND ANY
EQUIVALENT NEW TERMS, AS SUCH GUIDELINES OR SYSTEMS ARE UPDATED.
S 2. This act shall take effect on the one hundred eightieth day after
it shall have become a law.

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